ISS Service Delivery Logs Available

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**Please Note:  In viewing please know that the logs only include Monday – Friday.  According to HHSC the form will not be changed, rather one can just scratch out one of the days listed and write Saturday or Sunday on it.  Also, the form to document On- and Off-site ISS does not provide instructions on what to enter into the fields labeled “Staff’ and Ratio”.

External workgroup members commented that many providers use Electronic Health Records (EHRs), thus asking if HHSC would remove the requirement that the provider must use the ISS service log created by HHSC.  HHSC has so far stated that they will consider and get back about this issue.  For now you may have to upload completed forms to your EHR system if possible for billing purposes.  Some EHR systems are creating the same form I believe in their program.

If you are having problems with how to fill out the forms, please scroll down the same page you find the link to click on to open the original document.  Here are the instructions for the 8615 form

INSTRUCTIONS:  Updated: 2/2023

Purpose

Form 8615 is used by Texas Health and Human Services Commission (HHSC) staff, as well as Home and Community-based Services (HCS) and Texas Home Living Service (TxHmL) Waiver program providers to document a service event for on-site and off-site individualized skills and socialization.

Procedure

When to Prepare

Form 8615 must be completed within 14 calendar days after the activity being documented is provided.

Form Retention

The program provider must maintain a copy of the completed Form 8615 in the individual’s record.

General Instructions

• Form 8615 must be used for only one individual.

• Form 8615 may be used for multiple billable service events. Each billable service event must have a begin and end time.

• Form 8615 is considered a Medicaid document used for Medicaid purposes. By using this form, you understand it is your responsibility to record accurate information, as this information may be subject to a court of law. Failure to record accurate information or deliberate falsification of documentation is strictly prohibited.

Detailed Instructions

Individual Name — Enter the individual’s name.

Place of Service(s) — Enter the address at which the billable activity occurred.

Level of Need — Enter the individual’s level of need.

Name of Individualized Skills and Socialization Provider — Enter the name of the entity.

Individualized Skills and Socialization Provider License Number — Enter the license number of the individualized skills and socialization provider.

Date and Days of the Week — Enter the date (month, day, year) when the billable activity occurred.

Time In — Enter the time when the billable activity started.

Time Out — Enter the time when the billable activity ended.

Name of Service Provider — The printed name of the service provider who provided the service event for on-site or off-site individualized skills and socialization.

Service Provider Signature — At least one service provider who provided the service event for on-site or off-site individualized skills and socialization must sign the form. If more than two service events occur in a calendar day, the service provider must complete a new Form 8615.

Initial all areas in which you assisted the person — Initial the box that corresponds to activities provided by the service provider. The services initialed must justify amount of time spent providing services. A minimum of one activity must be marked for a billable service claim to have occurred.

Community Locations Visited and Special Events or Occurrences — This field is required to identify the location(s) for off-site individualized skills and socialization and may be used to document special events or occurrences. If providing written documentation, enter the date on which the billable activity occurred and the staff initials.

Initials — Enter the initials of the service provider(s) providing billable activities to the individual.

Questions

To inquire about Form 8615 or instructions, email hcspolicy@hhs.texas.gov.